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/ <br /> Application For ����� / <br /> �i��� PUBLIC WORKS PERlVIIT Date <br /> �c <br /> PUBLIC WORKS DEPARTMENT Public Works Pertnit k __.7��� <br /> 3200 Cedar Street <br /> Everett,WA g8207 259-8810 <br /> ��L � 5 �099 Buildii�g Permit# <br /> TYPE OR PRINT ONLY TO POSTI N G public Works Fee S�/Uc��ll�l� � <br /> � /���" ��i��L—` /c�E_�. //I�C. /� .Si���'/�/T . <br /> ner M iling Address City Zip Phone <br /> Applicant Maiiing Address Ciry Zip Phone <br /> Describe Proposed Work��G�/��/I�G' � <br /> W <br /> F- <br /> - <br /> PROJECT ADDRESS(if known) � �c� - �� � <br /> Attach four(4)copies ot plans for proposed work-Draw to scale an,� ote the following if applicabie: ' ��7��_ <br /> •PropeAy Lines 'Outline and dimensions of all exisling and pmposed structures on Ihe lot •Existing and proposed utilities '� <br /> •Centedine of street •Indicate Norih •Show any proposed g�ading changes •Show measurements � �i <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS: � <br /> 1. All calls for inspection shall be made 24 hours in advance- phone 259-8810. � <br /> 2.All work shall i�e pertormed in accordance with this permit and current City of Evarett Design and <br /> Construction Standards and Specifications. <br /> 3. Call Location Underground Service 4d hrs. before you dig. TOLL FREE NUMBER 1-800-424-5555. � <br /> � �v�=� ���12`� �L!j�; O � <br /> a <br /> ^� �� _„ ACKNOWLEDGEMENT OF CONDITI6NS <br /> ,�� _ The undersigned owner/applicant hereby agrees to hold and save harmless <br /> the City of Everett Irom any and all claims for damagos,costs,expenses,or <br /> � causes of action that may arise because of installation and maintenance of <br /> Appr e orCo� tructio Date theimpmvementorotherdght-of-wayuseheretoappliedfo�andfurtheragrees <br /> to remove same upon notice from ihe City and to replace pu6lic pmperty <br /> �` 6�Q� damaged thereby. <br /> � — <br /> FINAL NSPECTION Date <br /> .4ppmved as Consiructed �'��'wY� <br /> lb <br /> Signaturo of A cant Date <br /> WORK AUTHORIZEU BY THIS PERMIT MUST BE STARTED WITHIN 1DQ DAYS OF DATE PERMIT IS ISSUED AND THEREAF7ER IS TO BE DILIGENTLY PURSUED TO <br /> COMPLEfION THIS PERMIT MAY BE CANCELLED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS Pf70JECT OVER 90 DAYS DURATION. <br />